Medical Ethics

In this article I explore how Cicely Saunders championed the hospice movement and initiated what became palliative care by representing her emotional connections with others. She became friends with dying patients and encouraged others to follow her example in listening to patients’ descriptions of pain. Her approach was radical at a time when she believed doctors routinely ‘deserted’ dying patients because it urged them to understand another’s embodied pain as inextricably bound up with the emotional impact of a terminal diagnosis. (...) Saunders’ attention to how patients expressed their experience is summed up in her term ‘total pain’, which communicates how an individual’s pain is a whole overwhelming experience, not only physical but also emotional, social and spiritual. Previous research frames ‘total pain’ in terms of narrative, emphasising Saunders’ focus on listening to her patients and her use of narratives as evidence in advocating for cultural and institutional change, both of which I understand as engaging with a patient’s emotional reality. However, as Saunders’ ideals become mainstreamed as palliative care and amid calls for ‘narrative palliative care’, I use evidence from Saunders’ extensive written output alongside archival material to suggest that, just as palliative care is by its nature not a single specific intervention, ‘total pain’ should not be understood as simply narrative. Building on existing work in this journal questioning the primacy of conventional understandings of narrative in the medical humanities, I demonstrate how Saunders’ prominent use of fragments and soundbites alongside longer case narratives demonstrates the limits of narrative, particularly when someone is dying. Saunders thus offers a case study for considering the implications that questioning the primacy of narrative as emotional evidence might have for our understandings of how empathy or advocacy can function, or be cultivated, in medical settings. (shrink)

COVID-19 has stressed healthcare systems across the globe. We present the experience of an intern medical officer working in a tertiary care hospital during the first wave of the pandemic in Sri Lanka. Her narrative describes how the stress of the pandemic brought into sharp focus the strengths and weaknesses in the health system. We suggest some strategies to improve our health services as the world faces the second wave and an uncertain future. These include structural changes in healthcare services (...) at institutional and national levels, focused educational programmes for healthcare professionals to impart generic skills of disaster management, and the development of telehealth services and computerisation of health systems. We believe that we must maintain this focus to ensure that our patients can be guaranteed quality healthcare in the future. (shrink)

This article examines the representation of human genomics in the British historical novel of the 1990s. A form which meditates on the past and its relationship to the present, the historical novel readily lends itself to the exploration of genealogy, heredity and inheritance. Forwarding an understanding of human history, and particularly of family history, as a direct and causal function of the genes, the neo-Darwinian explanation of the genome popular in the 1990s similarly advanced its own teleological relationship between past (...) and present. Reading Jenny Diski’s Monkey’s Uncle, A S Byatt’s Babel Tower and Zadie Smith’s White Teeth, this essay argues that the historical novel provides a unique form with which to critique the deterministic view of heredity promoted by neo-Darwinism. Focusing on moments of textual anachronism, asynchronicity and repetition in these family sagas, it shows how—at its most transgressive—the historical novel imagines temporal disruptions that bring the present into contact with the past in ways that defamiliarise conventions of linearity, order and progress. Refusing the idea of human history as a single, legible line that underpins neo-Darwinian ideas of genetic inheritance, Diski, Byatt and Smith’s novels are able to interrogate both the temporal logics and cultural capital of 1990s genetic science. While the decade was shaped and defined by popular science speculation and large-scale genetic research projects, such as the Human Genome Project, the novels addressed in this essay ultimately suggest the lively and seductive genocentrism of the 1990s to be inadequate to the task of explaining the complexity and meaning of the lived genome. As Diski, Byatt and Smith’s novels anticipate, the question of the uses, meanings and value of the human genome sequence continue to be of relevance within our current, postgenomic era. (shrink)

Face-coverings were widely mandated during the Covid-19 pandemic, on the assumption that they limit the spread of respiratory viruses and are therefore likely to save lives. I examine the following ethical dilemma: if the use of face-masks in social settings can save lives then are we obliged to wear them at all times in those settings? I argue that by en-masking the face in a way that is phenomenally inconsistent with or degraded from what we are innately programmed to detect (...) as human likeness, we are degrading the social quality of our relations. Drawing on my previously published proof that Self is socially reflexive (mutually mirrored) rather than monadic in its constitution, I conclude that any widespread en-masking is also deleterious to humanity and therefore unethical. (shrink)

This is the first book to explore the epistemology and ethics of advanced imaging tests, in order to improve the critical understanding of the nature of knowledge they provide and the practical consequences of their utilization in healthcare. Advanced medical imaging tests, such as PET and MRI, have gained center stage in medical research and in patients’ care. They also increasingly raise questions that pertain to philosophy: What is required to be an expert in reading images? How are standards for (...) interpretation to be fixed? Is there a problem of overutilization of such tests? How should uncertainty be communicated to patients? How to cope with incidental findings? This book is of interest and importance to scholars of philosophy of medicine at all levels, from undergraduates to researchers, to medical researchers and practitioners (radiologists and nuclear physicians) interested in a critical appraisal of the methodology of their discipline and in the ethical principles and consequences of their work. -/- . (shrink)

The "morning morality effect"-the alleged phenomenon that people are more likely to act in unethical ways in the afternoon when they are tired and have less self-control than in the morning-may well be expected to influence prehospital anaesthesiologist manning mobile emergency care units (MECUs). The working conditions of these units routinely entail fatigue, hunger, sleep deprivation and other physical or emotional conditions that might make prehospital units predisposed to exhibit the "morning morality effect". We investigated whether this is in fact (...) the case by looking at the distribution of patient transports to hospital with and without physician escort late at night at the end of the shift as a surrogate marker for changing thresholds in ethical behaviour. All missions over a period of 11 years in the MECU in Odense were reviewed. Physician-escorted transports to hospital were compared with non-physician-escorted transports during daytime, evening, and night-time (which correlates with time on the 24 h shifts). In total, 26,883 patients were transported to hospital following treatment by the MECU. Of these, 27.4% (26.9%-27.9%) were escorted to the hospital. The ratio of patient transports to hospital with and without physician escort during the three periods of the day did not differ (p = 1.00). We found no evidence of changes in admission patterns over the day. Thus, no evidence of the expected "morning morality effect" could be found in a prehospital physician-manned emergency care unit. (shrink)

In this paper, I explore the 2012 face transplant performed on US recipient Richard Norris and how it was represented by the media as a ‘makeover story’. Informed by press coverage from the date of the transplant to the present day, I examine a widely viewed and critically acclaimed investigative report that aired on CBS’s 60 Minutes entitled ‘My Brother’s Keeper’. Through a close reading of both its form and content, I claim that the report’s makeover story consists of four (...) key themes: heroic medicine and miraculous science; appearance-based stigma and social alienation; appearance-based conformity and social assimilation; and subjective alterity and embodied hybridity. In doing so, I contend that the report’s themes contain the widespread ambivalence about facial transplantation by confirming prevailing assumptions about medical science and how it creates normal people who live good lives. That said, I also contend that the report’s themes complicate these assumptions by highlighting how facial transplantation invariably involves immediate encounters with otherness and corporeal interconnectedness. I conclude that the report’s makeover story—characterised as it is by the constraints of the before-and-after format—must be rethought and, ultimately, reworked if we wish to do justice to face transplant recipients. (shrink)